Catherine Cattley¹, Paola Massari¹, Caroline A. Genco^1,2*

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¹ Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, USA.
² Department of Microbiology, Boston University School of Medicine, Boston, USA.
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Abstract: The sexually transmitted infections (STIs) gonorrhea and chlamydia are known to disproportionately affect impoverished communities and communities of color, especially in urban areas. Moreover, socioeconomic and demographic factors such as poverty and race/ethnicity may contribute to a difference in treatment setting choice as well as a delay in care seeking. In an urban metropolitan area such as Boston, the overall gonorrhea and chlamydia rates are higher than national rates, and such differences are even more marked in certain neighborhoods with greater proportions of individuals who are impoverished, young, and of color. Using a retrospective analysis of city wide data, we highlight the effects of socioeconomic and demographic variables on urban STI prevalence. High poverty rates, race/ethnicity and younger adult populations are linked to disproportionately high STI rates. Interestingly, STI rates do not appear to be influenced by the universal health care coverage offered to the whole Massachusetts’ resident populations. We examine the effects of these variables in Boston neighborhoods in conjunction to STI rates and hypothesize that the observed rates are underestimates of the true prevalence of infection. Future studies will investigate how these same socioeconomic and demographic factors influence which treatment settings are chosen and subsequently lead to a delay in treatment.

Keywords: Gonorrhea, Chlamydia, Social Determinants of Health, Poverty, Boston

Cite this paper: Cattley, C. , Massari, P. , Genco, C. (2015) Incidence of Gonorrhea and Chlamydia in Urban Settings: The Case for Neighborhood Level Analysis in Boston. Advances in Infectious Diseases, 5, 162-166. doi: 10.4236/aid.2015.54020.

References

[1]   Springer, Y.P., Samuel, M.C. and Bolan, G. (2010) Socioeconomic Gradients in Sexually Transmitted Diseases: A Geographic Information System-Based Analysis of Poverty, Race/Ethnicity, and Gonorrhea Rates in California, 2004-2006. American Public Health Association, 100, 1060-1067.
http://dx.doi.org/10.2105/AJPH.2009.172965

[2]   (2012) Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2011. Department of Health and Human Services, Atlanta.

[3]   Anonymous (2013) Gonorrhea—CDC Fact Sheet.
http://www.cdc.gov/std/gonorrhea/STDFact-gonorrhea-detailed.htm

[4]   Zhou, X., Brown, C.J., Abdo, Z., et al. (2007) Differences in the Composition of Vaginal Microbial Communities Found in Healthy Caucasian and Black Women. The ISME Journal, 1, 121-133.
http://dx.doi.org/10.1038/ismej.2007.12

[5]   Bunnell, R.E., Dahlberg, L., Rolfs, R., et al. (1999) High Prevalence and Incidence of Sexually Transmitted Diseases in Urban Adolescent Females despite Moderate Risk Behaviors. Journal of Infectious Diseases, 180, 1624-1631. http://dx.doi.org/10.1086/315080

[6]   Fergus, S., Zimmerman, M.A. and Caldwell, C.H. (2007) Growth Trajectories of Sexual Risk Behavior in Adolescence and Young Adulthood. American Public Health Association, 97, 1096-1101.
http://dx.doi.org/10.2105/AJPH.2005.074609

[7]   Adimora, A.A. and Schoenbach, V.J. (2005) Social Context, Sexual Networks, and Racial Disparities in Rates of Sexually Transmitted Infections. Journal of Infectious Diseases, 191, S115-S122. http://dx.doi.org/10.1086/425280

[8]   Boston Public Health Commission (2013) Health of Boston 2012: A Neighborhood Focus. Research Office, Boston.

[9]   Kahn, C.B. and Martin, J.K. (2011) The Measure of Poverty: A Boston Indicators Project Special Report. The Boston Foundation, Boston.

[10]   Boston Public Health Commission (2012) STIs in Boston: Chlamydia Brief 2011.

[11]   Boston Public Health Commission (2012) STIs in Boston: Gonorrhea Brief 2011.

[12]   Marmot, M. (2005) Social Determinants of Health Inequalities. The Lancet, 365, 1099-1104.
http://dx.doi.org/10.1016/S0140-6736(05)74234-3

[13]   Dean, H.D. and Fenton, K.A. (2010) Addressing Social Determinants of Health in the Prevention and Control of HIV/AIDS, Viral Hepatitis, Sexually Transmitted Infections, and Tuberculosis. Public Health Reports, 125, 1-5.

[14]   Sharpe, T.T., Vo?te, C., Rose, M.A., Cleveland, J., Dean, H.D. and Fenton, K. (2012) Social Determinants of HIV/AIDS and Sexually Transmitted Diseases among Black Women: Implications for Health Equity. Journal of Women’s Health, 21, 249-254. http://dx.doi.org/10.1089/jwh.2011.3350

[15]   Table DP05. US Census Bureau. Accessed 18 September 2013. http://factfinder2.census.gov

[16]   Table S0101. US Census Bureau. Accessed 18 September 2013. http://factfinder2.census.gov

[17]   Parrish, D.D. and Kent, C.K. (2008) Access to Care Issues for African American Communities: Implications for STD Disparities. Sexually Transmitted Diseases, 35, S19-S22.
http://dx.doi.org/10.1097/olq.0b013e31818f2ae1

[18]   Geisler, W.M., Chyu, L., Kusunoki, Y., Upchurch, D.M. and Hook III, E.W. (2006) Health Insurance Coverage, Health Care-Seeking Behaviors, and Genital Chlamydial Infection Prevalence in Sexually Active Young Adults. Sexually Transmitted Diseases, 33, 389-396.
http://dx.doi.org/10.1097/01.olq.0000194584.80513.4a

[19]   GT Alert (2006) An Act Providing Access to Affordable, Quality, Accountable Health Care—An Outline of the New Massachusetts Health Insurance Legislation and Its Effects on Employers.
http://www2.gtlaw.com/pub/alerts/2006/0404.pdf

[20]   Boston Public Health Commission (2010) Health of Boston 2010: Access to Health Care. Research Office, Boston.

[21]   Hogben, M. and Leichliter, J.S. (2008) Social Determinants and Sexually Transmitted Disease Disparities. Sexually Transmitted Diseases, 35, S13-S18. http://dx.doi.org/10.1097/olq.0b013e31818d3cad

[22]   Thomas, J.C. and Sampson, L.A. (2005) High Rates of Incarceration as a Social Force Associated with Community Rates of Sexually Transmitted Infection. The Journal of Infectious Diseases, 191, S55-S60. http://dx.doi.org/10.1086/425278